*Name:
Title:
Institution:
Address:
City: State: Zip Code:
*Email:
Phone:
Fax:
Contact Person:
Contact Phone Number:
Contact Email:
Please briefly describe your research topic and/or potential questions.
What are the approximate dates of data collection you prefer for your survey?
What number of completed interviews is your target?
What is the population from which you wish to draw your sample of potential respondents?
What length do you expect your questionnaire to be? Pages Minutes Questions, of which are open-ended requiring coding
In addition to data collection, what services would you expect the SCSU Survey to provide? Questionnaire design consultation Coding of open-end questions Data analysis and report writing Other
Who will provide funding for the study?
On what date do you expect to submit a funding proposal for this project AND on what date do you expect a funding decision to be final?
Is there anything else we should know about your study at this point?